Hello, I'm new here, not sure how to call this topic and whether this is the right place. I do feel quite hopeless and have some questions regarding doctors and medications.

I live in London over a year, soon after my arrival had to start again with antidepressant (I used to see a psychiatrist and take antidepressant earlier, before arriving to UK).

I went to the medical practice where I am registered, expecting to be referred to a psychiatrist, but was prescribed my medication by the GP. When I needed to change the medication I didn't even get to see the same GP, as it's hard to get ANY appointment, let alone choosing which GP of the practice (there's about 7 GPs there). Recently I needed to change my medication as the one I was taking stopped working, got to see another GP of the practice and got a new medication. She basically gave me the choice whether I want to increase the dosage or change for a new med.

My question is whether this is a standard way of treating depression? Not being referred to a psychiatrist? Who gets to see a psychiatrist then?

I guess I'd be happy with this if all went well, but it didn't. After several days with my new med (Mirtazapine) I feel like this medication is just very wrong for me, but, what is worse, I don't think that the GP knew much about this medication, it seems as if it was chosen randomly. As I found out, Mirtazapine is suitable for people with insomnia, as it is sedating. I have the opposite problem though-one of my symptoms is that I tend to sleep too much, have troubles to wake up, and I did tell this to the GP. Now with Mirtazapine I find it almost impossible to get up, and once I do, I seem to be even more depressed than before, I have thoughts that I just want to die too often now so that I don't have to experience what I'm experiencing (I mean feel what I'm feeling).

Here is my second question - I don't know if I should go and see the doctor again or whether I should wait for some time and if it still doesn't get better then see the doctor. I had my first dose on Saturday night. I know it's said it might take couple weeks till the meds start working, but I think I am quite sensitive to medication and react faster - for example Citalopram literally saved me within couple days. And I can't imagine having to survive another week like this.

I would be very grateful for your responses.

goodnight

I can't answer the question about the GP issue as I don't live in the UK.
As for mirtazapine, though, it is very sedating at the intial low dose. Once you get up to therapeutic dosage of 30-45mg, it is actually quite activating. I'm like you, my depression leads to hypersomnia, and at the normal dosage for mirtazapine, I was surprised by the energy and motivation it gave me because every other med just exacerbates my ever-present sleepiness. Another plus is that mirtazapine is proven to start working within 2 weeks, compared to all other ADs that take 6-8 weeks.
It's also normal to feel more depressed the first couple weeks starting a new medication. Some people get the placebo effect (meaning they think the med is working right away, but it's not because it takes time to build up the neurotransmitters), but others feel worse for a while.
I'd really recommend giving it a few weeks and see how it goes. Although if your doctor just wrote you a script for 15mg and didn't plan for a follow-up, you should do so and ask about getting off the initial dose and onto the therapeutic one.

This post has been edited by amakgv: Feb 18 2009, 07:48 PM

hello, thanks a lot for your reply!
I'd like to ask how long did you take the initial 15mg dose, when is the time to go on to the therapeutic one?
The doctor I saw said we might need to increase the dose if necessary-she didn't seem to know anything about the therapeutic dosage..
thanks again

I really don't know much about the health care system in the UK, but here in the US I know that in many areas there are shortages of psychiatrists. When I wanted to make an appointment, I could only find one that was taking new patients. I'm wondering if that's why you haven't been referred on by the GP's?

Take care,
Dewayne

When I saw my doctor about trying mirtazapine, I told her straight out that I can not stay on the low dose for long. I have 2 small children I need to be awake for! My dosing schedule was titrated quickly, 3 days at 15mg, 3 days at 30, and then I was on 45. I had relatively few side effects, and after a couple days adjusting to 45 I really started to feel some improvement in my energy/motivation levels.
Normally the dose is increased after 7-14 days, depending on how you're doing.

I know this post's been here a while.
But I live in London, and have been prescribed mirtazapine - by a psychiatrist.
It is the right med for me, as insomnia and anxiety are major features of my illness.
I was referred to the psychiatrist for an urgent medication evaluation when I had a breakdown whilst taking efexor. I was prescribed efexor seemingly randomly by a GP who didn't know me - nor listened to my symptoms.
However since starting taking anti-depressants, I was encouraged to see the same GP at each visit. I chose the GP at the practice who I feel most comfortable with, and have been seeing every 2-3 weeks the past 4 or so years. I also see a psychotherapist privately 3 times a week - this was in place prior to meds.
Once I was off efexor completely, and stabilised on the mirtazapine, I was discharged by the psychiatrist with full agreement of myself and my treatment team, and my GP now monitors my medication as well as offering support and reassurance as I navigate my recovery journey.

It is very common for GPs in the UK to diagnose and treat depression due to the huge demands for the psychiatric services and how over stretched they are. Referal to a psychiatrist only happens when there is considered to be a more serious problem or if the depression/ anxiety are very very severe and treatment has not helped. If a patient is in crisis then urgent admission via A&E might be considered, or if the patient is under 18.

I'm in the UK. A GP will practice much like you've been treated. You will be asked to fill in a questionairre about how bad your depression is, if it's over a certain score the GP will refer you to a psychiatrist. The waiting list is very long. I had to wait four years exactly to get treatment for CBT. That's a long time, but you have to learn to be patient with these things. There's no quick fix and I had to learn to help myself.

As for the meds they can take an awful long time to work so I really wouldn't try and get anxious about them not working. What is so hard about the side effects of Mirtazepine? A headache or sedation really isn't so bad considering they will disappear in time.

in my case the side effects were much worse than that. i actually felt even more depressed, i had something which i could describe as violent fits of depression - sudden and not stopping. after increasing the dose even worse. every day seemed just never-ending suffering to me, don't know how much longer would i bear to wait. i'm off them now.

Hi,

Remember, just because one med didn't work, it doesn't mean they all won't. There are several on the market that work in different ways. I was on one med that has helped many people - but I wasn't one of them. It made me have mood swings, as in Bipolar, rapid cycling. But the next med helped me more than any previous med I'd been on. Unfortunately there's no scientific way to pick the right med for a patient, and it can be very frustrating. I know from all those months I was on the other med.....

Take care,
Dewayne

Yeh. I agree. Sounds familiar to me.

My GPs is the same. Difficult to get an appt, even worse to get to see the same doctor. Different GPs seem to have different levels of knowledge. Sometimes I think I know more about it sometimes.

I did get eventually refered to a psychiatrist after badgering my GP. First I had to see a mental health nurse to assess, waited even longer, then eventually saw a pdoc.

He was very good and I saw him a few times. However, when I'd stabilised a bit it was time to be sent back to my GP.
Trouble is then the GP refused to prescribe what the pdoc recommended (seroquel because it was an off label use !!!). Nightmare or what?

Luckily, my pdoc had written the GP a letter advising him what to do next. Even though my GP still refused to prescribe seroquel, the pdoc had recommended clomipramine which is working out pretty well for me.

Trouble is if this hadnt worked it would have been wait for another pdoc referral again....

Wait for CBT was yonks but fortunately, my employers heatlh insurance paid for it privately. Lucky cos it was 8 sessions at £65 a throw - gulp !!!!

Not going to criticise the NHS because it is free for everyone and short of money, but I think sometimes the care providded can be a bit second classs compared to some countries (like the US).